TL;DR

  • Incidence skews male (risk-ratio ≈ 1.3–1.5).
  • Prevalence is ≈ 1 : 1 because women develop the disorder later and live longer with it.
  • Ethnic gaps are larger than sex gaps: Black Caribbean incidence in the UK ≈ 9 × White; Māori prevalence ≈ 3 × non-Māori; remote Aboriginal Australians ≈ 2 × the national mean.
  • Asian-ancestry groups usually sit below White baselines; Hispanic data cluster near parity.
  • Tables below collate raw numbers from large meta-analyses, national registers, and first-episode studies (post-2010 wherever possible).

1 | Sex Differences: The Data#

MetricMenWomenMale : FemaleKey Source
Global median incidence15 / 100,000 yr11 / 100,000 yr1.4Aleman 20031
Global point prevalence (GBD 2016)0.28 %0.28 %1.0IHME 20182
Lifetime risk to 72 y (Denmark)1.59 %1.17 %1.36Pedersen 20143
China modelled prevalence0.37 %0.47 %0.79Charlson 20184

Key pattern: Incidence edges male; prevalence flattens toward 1 : 1. Outliers (e.g., female-heavier China) often coincide with higher male excess mortality.

2 | Ethnic & Racial Differences: Headline Findings#

Country / SettingGroupIncidence (/100 k yr)Prevalence (%)Fold-Change vs Local MajorityReference
UK (ÆSOP)White British7.2~11 ×Kirkbride 20135
Black Caribbean70.7—≈ 9 ×〃
Black African40.3—≈ 6 ×〃
South Asian11.3—1.5 × (n.s.)〃
USAWhite—~11 ×Bresnahan 20216
Black / African-American—~2≈ 2 ×〃
Hispanic / Latino—~1≈ 1 ×〃
Asian-American—< 1↓〃
New ZealandMāori—0.97≈ 3 × vs non-MāoriDurie 20047
Australia (Cape York)Remote Indigenous—1.7≈ 2 × vs national meanHeffernan 20178

Bold figures mark the largest observed excesses. n.s. = difference not statistically significant in that study.

3 | Grand Matrix (Sex × Ethnicity)#

PopulationPrevalence %Incidence /100 k yrMale : FemaleEthnic Contrast
Global mean0.2815.21.4—
DenmarkCum. risk: ♂ 1.59 / ♀ 1.17—1.36—
USA – Black vs White2 vs 1—~1.12 ×
UK – Black Caribbean—70.7n/a9 × vs White
UK – Black African—40.3n/a6 × vs White
UK – South Asian—11.3n/a1.5 ×
NZ – Māori0.97 vs 0.32—n/a3 ×
Australia – Remote Indigenous1.7 vs 0.8—~22 ×

4 | Why Incidence ≠ Prevalence#

Prevalence = Incidence × Average Years Ill

Incidence counts new diagnoses per year. Duration captures how long someone remains alive and meets diagnostic criteria. Multiply them and you get Prevalence, the snapshot most lay sources quote.

Sex-specific levers#

  1. Earlier onset in men – peak onset ≈ 22 y vs 26 y in women1.
  2. Higher premature mortality in men – life-years lost ≈ 15.5 vs 119.
  3. Late-onset second peak in women – post-menopausal cases shove female prevalence upward after age 4510.

A back-of-envelope:

Men: 18/100,000 yr × 35 yrs ≈ 0.63 % Women: 13/100,000 yr × 45 yrs ≈ 0.59 %

Close enough to parity.

5 | Methods in Plain English#

  • Search window: Peer-reviewed papers & WHO/GBD outputs 2000–2024.
  • Inclusion: Studies with ≥ 50,000 population base or national registers; DSM-III+, DSM-IV, DSM-5, or ICD-10/11 diagnostic frames; explicit sex or ethnicity breakdown.
  • Exclusion: Small clinic samples, convenience cohorts, or studies mixing schizophrenia with organic psychoses unless separated analytically.
  • Numbers reported: Point prevalence, period prevalence (12-month), lifetime morbid risk, or first-episode incidence. Where multiple estimates existed, the most recent high-quality figure was taken.
  • Ethnicity labels: Author terminology retained (e.g. “Black Caribbean,” “Māori”). Where necessary, categories were harmonised (e.g. U.S. Census “Black or African American”).

6 | Interpretation & Caveats (No Speculation)#

  • Diagnostic criteria: Modern studies use DSM-III+, DSM-IV, DSM-5 or ICD-10/11. Sex ratio shifts seen when earlier, stricter criteria are replaced by current ones have been formally documented11.
  • Registers vs surveys: Nordic registers capture treated cases only; community surveys may pick up untreated illness.
  • Migration status: Several European studies observe elevated risk in first- and second-generation migrants, particularly those of African descent.
  • Mortality bias: Higher excess deaths in men (and in some minority groups) can pull prevalence downward relative to incidence.
  • Data gaps: Many low-income countries lack reliable ethnic breakdowns; global prevalence therefore hides within-country heterogeneity.

7 | Frequently Asked Questions#

Q 1. If men’s incidence is higher, shouldn’t prevalence be higher in every age band?
A. Not once survival differences are considered. Men’s earlier onset yields more early-life cases, but their greater premature mortality and the extra late-onset cases among women balance whole-population snapshots.

Q 2. Do the large ethnic gaps in the UK replicate elsewhere?
A. Yes, though magnitudes vary. Scandinavian registers, Dutch municipal cohorts, and Canadian studies report 3–5 × excess incidence among African or Caribbean origin migrants vs host-nation Whites.

Q 3. Could diagnostic bias explain the Black Caribbean 9 × figure?
A. Standardised interviews (SCID, Schedules for Clinical Assessment in Neuropsychiatry) still show ≥ 5 × excess after controlling for misclassification. Bias contributes but does not erase the gap.

Q 4. Are Asian-ancestry rates genuinely lower or under-detected?
A. Both factors likely operate. Epidemiological catchment surveys find lower true incidence, but cultural help-seeking patterns can also postpone diagnosis.

Q 5. Has the sex incidence gap narrowed over time?
A. Not materially. Meta-analyses from the 1990s through 2020 show stable male : female incidence ratios around 1.3–1.5.

8 | Footnotes#

9 | Full Bibliography#

  1. Aleman, A., Kahn, R. S., & Selten, J.-P. (2003). Sex Differences in the Risk of Schizophrenia. Archives of General Psychiatry, 60(6), 565–571.
  2. Charlson, F. J. et al. (2018). Global Epidemiology and Burden of Schizophrenia. Psychological Medicine, 48(11), 1859–1870.
  3. GBD 2016 Schizophrenia Collaborators. (2018). Global, Regional, and National Burden of Schizophrenia. The Lancet Psychiatry, 5(12), 989–1023.
  4. Heffernan, E. B. et al. (2017). Prevalence of Mental Illness among Indigenous Australians in Remote Communities. Medical Journal of Australia, 207(4), 161–166.
  5. Hjorthøj, C., Stürup, A. E., McGrath, J. J., & Nordentoft, M. (2017). Years of Potential Life Lost and Life Expectancy in Schizophrenia. The Lancet Psychiatry, 4(4), 295–301.
  6. Kirkbride, J. B. et al. (2013). Incidence of Schizophrenia and Other Psychoses in England, 1950–2009. British Journal of Psychiatry, 202(1), 64–71.
  7. Pedersen, C. B. et al. (2014). Nationwide Lifetime Risk of Mental Disorders in Denmark. JAMA Psychiatry, 71(6), 573–581.
  8. Riecher-Rössler, A. (2016). Late Onset Schizophrenia—What Is Unique? Current Opinion in Psychiatry, 29(3), 201–205.
  9. Selten, J.-P., & Cantor-Graae, E. (2005). Social Defeat: Risk Factor for Schizophrenia? British Journal of Psychiatry, 187, 101–102.
  10. Durie, M. (2004). Māori Health and Mental Health. New Zealand Medical Journal, 117(1199), U1091.
  11. Bresnahan, M. et al. (2021). Race and Ethnicity in the Incidence of Psychotic Disorders. Psychiatry Research, 295, 113627.

  1. Aleman, A., Kahn, R. S., & Selten, J.-P. “Sex Differences in the Risk of Schizophrenia.” Arch Gen Psychiatry 60 (2003): 565–571. ↩︎ ↩︎

  2. GBD 2016 Schizophrenia Collaborators. “Global, Regional, and National Burden of Schizophrenia.” Lancet Psychiatry 5 (2018): 989–1023. ↩︎

  3. Pedersen, C. B. et al. “Nationwide Lifetime Risk of Mental Disorders in Denmark.” JAMA Psychiatry 71 (2014): 573–581. ↩︎

  4. Charlson, F. J. et al. “Global Epidemiology and Burden of Schizophrenia.” Psychol Med 48 (2018): 1859–1870. ↩︎

  5. Kirkbride, J. B. et al. “Incidence of Schizophrenia and Other Psychoses in England, 1950–2009.” Br J Psychiatry 202 (2013): 64–71. ↩︎

  6. Bresnahan, M. et al. “Race and Ethnicity in the Incidence of Psychotic Disorders.” Psychiatry Res 295 (2021): 113627. ↩︎

  7. Durie, M. “Māori Health and Mental Health.” NZ Med J 117 (2004): U1091. ↩︎

  8. Heffernan, E. B. et al. “Prevalence of Mental Illness among Indigenous Australians in Remote Communities.” Med J Aust 207 (2017): 161–166. ↩︎

  9. Hjorthøj, C. et al. “Years of Potential Life Lost and Life Expectancy in Schizophrenia.” Lancet Psychiatry 4 (2017): 295–301. ↩︎

  10. Riecher-Rössler, A. “Late Onset Schizophrenia—What Is Unique?” Curr Opin Psychiatry 29 (2016): 201–205. ↩︎

  11. Castle, D. J. et al. “Gender Differences in Schizophrenia: Hormonal Effect or Subtype Effect?” Acta Psychiatr Scand 97 (1998): 17–24. ↩︎